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Core Conditions > RRAPID > Flashcards

RRAPID Flashcards

1
Q

What are the signs of acute severe asthma ?

A
  • use of accessory muscles

- wheeze

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2
Q

What are the features of acute severe asthma ?

A
  • inability to complete sentences in one breath
  • respiratory rate >25
  • HR > 110
  • PEFR 33-50% of expected
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3
Q

Features of life threatening asthma attack ?

A
  • altered conscious level
  • exhaustion/poor respiratory effort
  • silent chest
  • PEFR
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4
Q

Features of near fatal asthma attack ?

A

Raised PaCO2/ requiring mechanical ventilation with raised pressures

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5
Q

What is the initial response in a severe acute asthma attack ?

A

O SHIT

  • oxygen: 15L non rebreath mask
  • salbutamol - 5mg nebs every 15/20 mins if PEFR
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6
Q

What investigations do you send for in acute severe asthma ?.

A
  • (IV access) bloods- FBC, U&Es, glucose ~CRP, Blood and sputum cultures if sepsis suspected
  • ABG (sats
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7
Q

What are the symptoms of an acute exacerbation of COPD ?

A
  • increasing cough

- reduced exercise tolerance

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8
Q

What are the signs of an acute exacerbation of COPD ?

A
  • use of accessory muscle
  • tachypnoea
  • cyanosis
  • wheeze
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9
Q

What drug treatment would be administered in an acute exacerbation of COPD ?

A
  • Oxygen (controlled, aim for sats 88-92%) - adjust O2 with Venturi mask, but in emergency 15L non rebreath first then titration down when reassess
  • Salbutamol 5mg neb
  • hydrocortisone 200mg IV/prednisolone 40mg PO
  • ipratropium bromide neb

*antibiotics if evidence of infections (empirical- broad spec) e.g. Amoxicillin

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10
Q

What investigation should you request in an acute exacerbation of COPD ?

A
  • bloods- FBC, U&Es, glucose
  • consider blood and sputum cultures if sepsis suspected
  • ABG (decreased PaO2, raised PaCO2 and raised bicarbonate if chronic disease)
  • CXR to exclude pneumothorax/infection
  • ECG (may show cor pulmonale)
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11
Q

If there is no response to nebuliser bronchodilators, oxygen and steroids what should be done next in an acute exacerbation of COPD ?

A

Non invasive, positive pressure ventilation

- if RR > 30, pH

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12
Q

What are the features of a pneumothorax ?

A
  • SOB, sudden onset
  • pleuritic chest pain
  • unilateral reduced chest expansion
  • unilateral deceased breath sounds
  • unilateral hyper resonance to percussion
  • CXR confirmation
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13
Q

What are the features of a tension pneumothorax ?

A

all same signs of pneumothorax (SOB, pleuritic pain, unilateral reduced expansion, decreased breath sounds, hyper resonance) AND:

  • hypotension (must be present to make diagnosis of tension pneumothorax)
  • tracheal deviation (away from affected side)
  • distended neck veins
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14
Q

What is the response to a tension pneumothorax ?

A
  • ABCDE assessment:
  • O2 15L/min via reservoir mask
  • needle decompression - large bore needle in 2nd intercostal space mid clavicular line
  • insertion of chest tube
  • DO NOT DELAY MANAGEMENT TO GET CXR*
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15
Q

What are the risk factors for PE ?

A
  • malignancy
  • post surgery
  • immobility
  • oral contraceptive pill
  • pregnancy
  • previous DVT or PE
  • increasing age
  • infection
  • dehydration
  • obesity
  • smoking
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16
Q

Symptoms of PE?

A
  • sudden SOB
  • pleuritic chest pain
  • haemoptysis
  • syncope
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17
Q

What imaging technique should be used to confirm PE ?

A

CT pulmonary angiogram

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18
Q

What drugs are administered in emergency treatment of massive PE ?

A
  • O2 15/L per min via reservoir mask
  • morphine (5-10mg IV)with antiemetic (if in pain or very distressed)
  • fluid bolus to treat hypotension
  • anticoagulant with LMWH e.g. Tinzaparin, enoxaparin
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19
Q

Signs of PE ?

A
  • hypotension, tachycardia (CV collapse)
  • gallop rhythm
  • raised JVP
  • right ventricular heave
  • pleural rub
  • tachypnoea
  • cyanosis
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20
Q

Investigations for PE ?

A
  • U&Es, FBC, baseline clotting
  • ECG - commonly normal
  • CXR - often normal ~ decreased vascular markings, small pleural effusion, wedge shaped area of infarct
  • ABG: hyperventilation and poor gas exchange -> low PaO2 and low PaCO2, pH often raised
  • D dimer
  • CT pul. Angiogram
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21
Q

What is the definition of status epilepticus ?.

A

Seizures lasting > 30 mins or repeated seizures without regaining consciousness

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22
Q

Features of status epilepticus ?

A
  • tonic clonic seizure
  • non convulsive status is more difficult
  • EEG can help confirm diagnosis
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23
Q

If Someone presents with seizures and they are pregnant what us the likely diagnosis ?.

A

Eclampsia

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24
Q

What investigations should be carried out in status epilepticus ?

A
  • bedside glucose
  • bloods: lab glucose, U&Es, FBC, Ca, Mg, LFTs
  • ABG
  • ECG
  • consider anticonvulsant levels, toxicology screen, LP, Blood culture and urine, carbon monoxide level
  • EEG
  • pulse oximetry, cardiac monitor
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25
Q

What drugs should be administered in status epilepticus ?

A
  • O2 15L/min non rebreath mask
  • Lorazepam (repeat after 5 mins if fits continue )
  • Phenytoin - if fits continue
  • Diazepam
  • continued seizures may require anaesthetist sedation
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26
Q

What are the symptoms of acute sever asthma ?

A
  • SOB (dyspnoea)
  • cough (often worse at night)
  • chest tightness
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27
Q

What bloods should you order in an acute MI ?

A

FBC, U&Es, calcium, magnesium, glucose,troponin

28
Q

Definition of acute kidney injury ?.

A
  • rise in serum creatinine greater than 26umol/L within 48 hrs

OR

-rise in serum creatinine 1.5 x baseline value within 1 week

OR

  • urine output less than 0.5 ml/kg/hr for 6 consecutive hours
29
Q

Risk factors for AKI ?

A
  • > 75 yrs
  • CKD
  • HF
  • PVD
  • liver disease
  • DM
  • nephrotoxins e.g. NSAIDs, gentamicin, iodinated contrast
  • hypovolaemia
  • sepsis
30
Q

Pre renal causes of AKI

A
  • dehydration (vom, diarrhoea, burns, haemorrhage)
  • hypotension
  • sepsis
  • HF
31
Q

Renal causes of AKI ?

A
  • prolonged hypo perfusion
  • nephrotoxins
  • glomerulonephritis
  • vasculitis
  • interstitial nephritis
32
Q

Post renal causes of AKI

A
  • obstruction e.g. Renal stones, bladder cancer, pelvic mass, enlarged prostate
33
Q

Signs of AKI

A
  • hypovolaemia - assess volume status (cap refill, pulse, bp, JVP, skin turgor, pul oedema, peripheral oedema, urine output)
  • palpable bladder
  • signs of vasculitis (weight loss, fever, rash, uveitis, haemoptysis, joint swelling
  • renal Bruits (renal artery stenosis)
34
Q

Investigations to be done in AKI

A
  • FBC, U&Es, bicarbonate, LFTs, calcium, phosphate
  • blood cultures if sepsis expected
  • urine dipstick (presence of blood and protein suggests infection or vasculitis)
  • CXR
  • renal tract ultrasound (exclude renal tract obstruction)
35
Q

Response in AKI

A
  • IV access
  • treat underlying cause (fluids for hypovolaemia, antibiotics for sepsis)
  • treat complications (hyperkalaemia, pul oedema, acidosis, pericarditis)
  • REVIEW DRUG CHART (dose adjustments and avoid nephrotoxins)
  • renal replacement if indicate (e.g. Intractable hyperkalaemia, pH
36
Q

How would you recognise hyperkalaemia ?

A
  • serum potassium >5mmol/L

- ECG changes - tall tented T waves, small P waves, wide QRS

37
Q

Causes of hyperkalaemia ?

A
  • oliguric AKI
  • potassium sparing diuretics (amiodarone, Spironolactone)
  • drugs e.g. ACEi
  • rhabdomyolysis
  • metabolic acidosis
  • Addison’s disease
  • massive blood transfusion
38
Q

What are the complications of hyperkalaemia

A
  • cardiac arrhythmias

- sudden death

39
Q

When is immediate treatment required in kyperkalaemia ?

A
  • potassium >6mmol/L with ECG changes

OR

  • potassium > 6.5mmol/L regardless of ECG change
40
Q

Immediate treatment of hyperkalaemia

A
  1. Calcium gluconate - 10%, 10mls over 2 mins (protects the heart)
  2. Insulin (short acting) and dextrose - insulin sats potassium into cells temporarily monitor BM
  3. Salbutamol neb - shifts potassium in to cells temporarily
  4. Calcium resonate - removes potassium from GI tract (co prescribe with lactulose)
  5. Renal replacement therapy for intractable cases
41
Q

Signs/symptoms of anaphylaxis ?

A
  • rash
  • urticaria (hives)
  • laryngeal oedema
  • angioedema (swelling if deep layers of skin)
  • severe bronchospasm
  • hypotension and shock
  • nausea, vomiting, diarrhoea
42
Q

What type of hypersensitivity reaction is anaphylaxis ?

A

Type 1, IgE mediated hypersensity

43
Q

Drugs administered in anaphylactic shock ?

A
  • Adrenaline (0.5 mg IM) *repeat as necessary, reassess every 5 mins
  • chlorphenamine 10mg IV
  • hydrocortisone 200mg IV
  • fluid bolus - Hartmanns 500ml stat (10-15 mins)
  • may need ionotropes/vasopressors to maintain BP
  • if audible wheeze treat for asthma
44
Q

What simple manoeuvre can be done to help restore circulation in an anaphylactic shock ?

A

Raise legs

45
Q

What blood tests should be sent for in an anaphylactic shock ?

A

FBC, U&Es, LFTs, calcium and glucose

46
Q

How would you recognise a broad complex tachycardia ?

A
  • ECG rate greater than 100 bmp
  • QRS complex > o.12s (3 small squares)
  • presence of pulse (if no pulse start advanced life support)
47
Q

What bloods should be tested in broad complex tachycardias ?

A

FBC, U&Es , LFTs, calcium, magnesium, glucose

48
Q

Response in broad complex tachycardia

A
  • give oxygen
  • IV access
  • attach cardiac monitor
  • monitor bp and O2 sats
  • 12 lead ECG
  • identify and treat underlying cause (e.g. Electrolyte disturbance esp. Hypo K and Mg)
49
Q

How would you recognise brandy arrhythmias ?.

A

ECG rate less than 50 Bpm

50
Q

How would you treat bradyarrhythmia with adverse features ?

A

Add atropine to standard treatment (O2, bloods, monitoring etc)

51
Q

How would you treat a narrow complex tachycardia with adverse features ?

A
  • synchronised DC shock
52
Q

How would you treat a REGULAR narrow comes tachycardia without adverse features ?

A
  • treat as Supraventricular tachycardia
  • use vagal manoeuvres
  • adenosine
53
Q

How would you treat an IRREGULAR narrow complex tachycardia ?

A
  • treat as for AF
  • digoxin or beta blocker for rate control
  • amiodarone for chemical cardio version and rate control
54
Q

What might be adverse features in a broad or narrow complex tachycardia ?

A
  • shock (systolic
55
Q

How would you treat a broad complex tachycardia with adverse features ?

A

Synchronised DC shock

56
Q

How would you treat a broad complex tachycardia without adverse features ?

A

Amiodarone

57
Q

What a the causes of pulmonary oedema ?

A
  • left ventricular failure
  • fluid overload
  • neurogenic
58
Q

What are the signs of pulmonary oedema ?

A
  • dyspnoea
  • orthopnoea
  • pink frothy sputum
  • pale, sweaty, distressed
  • raised JVP
  • inspiratory crackles
  • wheeze
  • triple gallop rhythm
59
Q

What findings would you see on a CXR in pulmonary oedema ?

A
  • cardiomegaly
  • fluffy bilateral shadowing with peripheral sparing (bat wing)
  • kerley b lines
  • pleural effusion
60
Q

Drug treatment in emergency presentation of pulmonary oedema ?

A
  • oxygen
  • diamorphine (caution in COPD and liver failure)
  • furosemide
  • glyceryl tri nitrate
  • salbutamol nebs if wheeze
61
Q

How would you recognise sepsis ?

A

Two or more of the following:

  • temp 38
  • HR > 90bmp
  • tachypnoea >20
  • white cell count 12
62
Q

What counts as severe sepsis ?

A

Sepsis (I.e. Due to infection) + organ disorder

63
Q

What is septic shock ?

A

Sepsis plus hypotension despite adequate fluid resuscitation

64
Q

What is the response to sepsis ?.

A

‘Sepsis 6’ - 6 things to be completed within an hour - use BUFALO:
B - blood cultures
U - urine output (catheter, monitor hourly)
F - fluid - treat hypotension
A - antibiotics- broad spec stat
L - lactate (and Hb) - measure
O - oxygen - 15L/min

65
Q

What is the most common cause of airway obstruction in adults ?

A

Reduced consciousness level

66
Q

What is see saw chest movement a sign of?

A

Complete airway obstruction

Core Conditions (15 decks)

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